Saturday, April 28, 2012

Sugar-Sweetened Drinks

Are sugar-sweetened soft drinks bad for you?
How do sugar-sweetened soft drinks compare to other drinks like diet soft drinks or low fat milk or water?

Besides the increased risk of dental decay just how bad are sugar-sweetened soft drinks?

Despite all the criticism about soft drinks, there have been few clinical trials lasting more than a few weeks that compare sugar-sweetened soft drinks to other beverages.
A recent study  from Denmark is very informative.

This study  randomly assigned 47 adult men and women to one of four groups and followed them over 6 months. Those groups were assigned to drink 1 liter (equal to just under three 12 ounce cans or about a quart) of one of the following beverages daily:
·      regular Coca Cola or
·      diet Coca Cola or
·      water or
·      reduced fat milk

The low fat milk provided about the same calories as the regular Coca Cola: about 450 calories. The diet soda provided only 15 calories per day and, of course, no calories came from the water.

In Europe,  Regular Coca Cola is sweetened with half glucose and half fructose. Unlike the U.S., Europe does not use high fructose corn syrup in their regular sodas. The diet Coca Cola used the sweetener aspartame.

Now you might think that a quart of soda is a lot, but in the U.S, over a third of those aged 18-34 years of age drink soft drinks several times a day. Drinking three 12 ounce cans daily would be just like these people did in this study.

And these participants were not at a healthy weight to start.
They had an average body mass index (BMI) of 31. 
A BMI of 25 but less than 30 is considered overweight.
A BMI of 30 and above is considered obese.

Their body fat was evaluated by magnetic resonance imaging (MRI) and magnetic resonance spectroscopy. 
And blood lipids (cholesterol and triglycerides) and blood pressure were carefully measured. Other measurements such as blood glucose and insulin were taken.

So what did the researchers find at the end of this 6 month trial?

Those drinking the regular sugar-sweetened soda had:
  • much more fat (130-200% more) in their liver and their muscles as compared to the other group
  • 32% higher blood triglycerides and 11% higher blood cholesterol as compared to the other groups

The systolic blood pressure appeared to be lower in the milk and diet soda groups as compared to the regular sugar-sweetened soda.
Diet soda, otherwise, had effects similar to water. This is consistent with a recent post.

There was no significant difference in weight in the four groups as compared to the baseline weight over the 6 months. That means that the groups drinking the diet soda and water must have taken in more calories from other sources, like food. And the groups drinking the caloric beverages, milk and regular soda, must have taken in less calories from other sources, like real food.

You may know that fat in your liver and muscle is not good.
Increased fat in these areas is associated with an increased risk of diabetes and heart disease.

Although this study had fairly few participants it was 6 months long and was well designed. Further work needs to be done to confirm and extend these findings.

In the meantime, I think this study provides more evidence to conclude: 
  • not all calories are the same
  • sugar sweetened drinks are nasty
  • it's best not to drink your calories

Saturday, April 21, 2012

Sleep, Appetite and Weight

Sleep, Appetite and Weight; Appetite Control Insights

If you can’t lose weight maybe sleep is the problem.
Adequate sleep is critical to controlling appetite and weight.
Inadequate sleep increases the risk for being overweight.
The connection between sleep, appetite and weight has been suspected for years
This association has also been seen in children.

And now more has been learned about the relationship between sleep, appetite, and weight.

The hormone ghrelin increases appetite. Ghrelin increases in the bloodstream after inadequate sleep.

The hormone leptin reduces appetite. Leptin is lower in the bloodstream after inadequate sleep.  
Multiple randomized controlled clinical trials have proven that people are more hungry if they do not get enough sleep.

If you do not get enough sleep you will be hungrier and probably get fatter.

And sleep should be normal not interrupted as it is if you have sleep apnea.

Not getting enough sleep increases snacking, especially evening snacking.

Even one night of reduced sleep can increase appetite and lower leptin levels.
And depending on the sleep lost, just taking a nap may not be too helpful.

Some studies suggest that metabolic rate even goes lower just after insufficient sleep. 
That means you would burn less calories just from not getting enough sleep.

Shift workers may run into even greater problems. A recent study shows that sleep deprivation coupled with changes in the wake sleep cycle or so-called circadian rhythm, lowered resting metabolic rate and the ability to secrete insulin. 
That means a higher risk of weight gain and diabetes. 
This finding would be very important for those who work varying shifts.

So how much sleep is enough?
That's not clear. But these studies showing these effects on hunger and appetite have demonstrated problems with 4 to 5 and half hours of sleep. These and other data suggest that 7-8 hours is a healthy amount of sleep.

A trial is being conducted to see if increasing sleep duration helps with weight loss. 

In the meantime, catch up on your sleep when you can. 
Getting at least 7-8 hours of sleep most of the time should help you control your appetite and weight.
Sleeping well doesn't guarantee eating well. But it will help.
Good night. 

Saturday, April 14, 2012

Insulin Before Surgery: Don’t Change the Lantus

It is shocking how many doctors and patients don't know what to do with insulin before surgery. Perhaps because there are no universally agreed upon guidelines. 
The Society for Ambulatory Anesthesia came up with some reasonable ones recently.

Mut maybe because of that lack of consensus, often anesthesiologists or surgeons tell patients to stop or reduce their Lantus insulin. Lantus and another insulin called Levemir are typically given in the evening. These insulins have no significant peak. That means they work fairly smoothly and evenly over many hours such that they do not tend to cause low sugars even without eating.

Now that statement is true if the patient is taking an appropriate amount of Lantus. Unfortunately, too often doctors, even some endocrinologists, prescribe huge doses of Lantus insulin, without also prescribing another type of insulin needed to control glucose rises from meals. An excessive dose of Lantus may require the person to eat to avoid getting hypoglycemia  (low blood sugar). Many doctors would benefit their patients by reading my previous post on how to use insulin.

In general, though, the long acting insulin, like Lantus can and should be given as usual in almost all patients before surgery. Some patients take Lantus in the morning. They too should take their insulin as usual even on the day of the surgery.

If the person has Type 1 Diabetes, reducing or stopping the Lantus can lead to severe hyperglycemia (high blood sugar) and serious, even life threatening problems. 
Diabetic ketoacidosis can quickly result in a person with Type 1 Diabetes who skips insulin. It would indeed be unfortunate if ketoacidosis happened because a doctor told that person to stop their Lantus.

I’ve seen it happen more than once.

That’s why our team always tells patients to call us for insulin instructions before surgery and not to listen to what others tell them.

These problems are completely avoidable.

Here’s hoping that surgery, if you need it, goes well.

Sunday, April 8, 2012

Is Alpha Lipoic Acid Good For You?

Is Alpha Lipoic Acid Good For You?
Should you take alpha lipoic acid if you have diabetes? 

What is this stuff anyway? Is it a vitamin or a mineral?

Your body makes alpha lipoic acid and it is found in most foods. Only about 40% of oral alpha lipoic acid is absorbed. Alpha lipoic acid is important for many body processes including energy production.
The chemical structure of alpha lipoic acid is shown below.

Alpha lipoic acid is neither a vitamin nor a mineral.
Although alpha lipoic acid can act as an antioxidant, how an antioxidant acts in your body,
good, bad or neutral, remains unclear. See my post on antioxidants.

Although some studies in the 1990s suggested improvement in  insulin action with alpha lipoic acid supplements, no study has shown a lowering of blood glucose or Hemoglobin A1c with alpha lipoic acid.

Most other studies with alpha lipoic acid have examined effects on diabetic neuropathy. 
The largest randomized controlled trial lasted 7 months and included over 500 patients. 
That study showed no benefit with intravenous alpha lipoic acid followed by oral doses of 600 milligrams three times a day.

Another study involving only 17 patients taking 800 mg. a day showed trivial, clinically insignificant effects on diabetic autonomic neuropathy.

One study of 120 patients with Type 1 and 2 diabetes done in Russia administered alpha lipoic acid intravenously for 14 treatments over 3 weeks and showed benefit in symptoms and nerve function.

The most recent trial lasted 4 years and examined the effects of alpha lipoic acid  600 mg given once a day by mouth on nerve function in 460 patients with both Type 1 and Type 2 diabetes. That study was a randomized controlled multi-center trial. Patients did not have to have pain from neuropathy to be included.
And that study failed. There was no significant difference between alpha lipoic acid and placebo in the primary outcome, the main measurement tested.

But in this last trial, there were a few findings suggesting some minor nerve benefits of alpha lipoic acid. But just how important those are is not clear.
In addition, there were more serious adverse events with alpha lipoic acid as compared to placebo.

And this last study was the among the best done with alpha lipoic acid for any condition.

Could alpha lipoic acid be good for weight loss?

Weight loss was not seen in those neuropathy studies.

But a randomized controlled trial published last year examined weight loss in 360 overweight Koreans  over 20 weeks.  A third of the participants had diabetes. All were instructed to follow a low calorie diet. One third were given placebo, one third got 1200 mg of alpha lipoic acid and the rest, 1800 mg of alpha lipoic acid.

Those given 1800 mg as 600 mg of alpha lipoic acid three times a day,  showed slightly more weight loss as compared to placebo.
But that was a measly 1% more than the placebo group, equivalent to 2.3 pounds. The 1200 mg. dose of alpha lipoic acid was no better than placebo. There was more hives and itching in the alpha lipoic acid groups.

Interesting results but not too impressive.

As far as alpha lipoic acid goes, my recommendations are: don't take it.

Your Diabetes Endocrine Nutrition Group